title: Is universal coverage via social health insurance financially feasible in Swaziland?
abstract: OBJECTIVE
  The Government of Swaziland decided to explore the feasibility of social health insurance (SHI) in order to enhance universal access to health services. We assess the financial feasibility of a possible SHI scheme in Swaziland. The SHI scenario presented is one that mobilises resources additional to the maintained Ministry of Health and Social Welfare (MOHSW) budget. It is designed to increase prepayment, enhance overall health financing equity, finance quality improvements in health care, and eventually cover the entire population.
  
  
  METHODS
  The financial feasibility assessment consists of calculating and projecting revenues and expenditures of the SHI scheme from 2008 to 2018. SimIns, a health insurance simulation software, was used. Quantitative data from government and other sources and qualitative data from discussions with health financing stakeholders were gathered. Policy assumptions were jointly developed with and agreed upon by a MOHSW team.
  
  
  CONCLUSIONS
  SHI would take up an increasing proportion of total health expenditure over the simulation period and become the dominant health financing mechanism. In principle, and on the basis of the assumed policy variables, universal coverage could be reached within 6 years through the implementation of an SHI scheme based on a mix of contributory and tax financing. Contribution rates for formal sector employees would amount to 7% of salaries and the Ministry of Health and Social Welfare budget would need to be maintained. Government health expenditure including social health insurance would increase from 6% in 2008 to 11% in 2018.
authors.affiliation: Department of Health Systems Financing, World Health Organization, Geneva, Switzerland. mathaueri@who.int
authors.forename: Inke
authors.initials: I
authors.lastname: Mathauer
authors.forename: Laurent
authors.initials: L
authors.lastname: Musango
authors.forename: Sibusiso
authors.initials: S
authors.lastname: Sibandze
authors.forename: Khosi
authors.initials: K
authors.lastname: Mthethwa
authors.forename: Guy
authors.initials: G
authors.lastname: Carrin
mesh_terms: D013541:Eswatini; D005240:Feasibility Studies; D005380:Financing, Government / Q000706:statistics & numerical data; D005382:Financing, Personal / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D009313:National Health Programs / Q000191:economics*; D019472:Universal Health Insurance / Q000191:economics*